Purpose: To review the epidemiology, clinical features, diagnosis, and management of patients with fungal keratitis. Methods: Review of the literature and summary of personal experience. Results: Fungi may be part of the normal external ocular flora but are found with greater frequency in diseased eyes. Trauma is the most frequent risk factor and often occurs outdoors and involves plant matter. The Gram and Giemsa stains are the most common stains used for the rapid identification of fungi. The only commercially available topical antifungal in the United States is natamycin 5% and it is therefore the first line treatment in most cases. The length of time required for topical treatment is on average 4 to 6 weeks but must be titrated based on clinical response. The most common surgical approach to fungal keratitis is daily debridement with a spatula or blade. Approximately one-third of fungal infections need additional surgical intervention, most commonly in the form of a therapeutic penetrating keratoplasty. The prognosis of fungal keratitis depends on the depth and size of the lesion; small superficial infections respond well to topical therapy. Deep stromal infections and infections with concomitant scleral or intraocular involvement are much more difficult to eradicate. Conclusions: The diagnosis of fungal keratitis can be quite challenging, and treatment requires prolonged antifungal therapy often combined with surgical intervention in the form of penetrating keratoplasty, conjunctival flap, or cryotherapy.